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Comment by matheusmoreira | Hacker News Reader

Depression exists. It is the most thoroughly researched psychiatric disorder. If left untreated, depression can lead to physical changes in the brain. It has enormous impact on the individual and society.

https://www.nimh.nih.gov/health/statistics/global/global-dal...

https://www.nimh.nih.gov/health/statistics/disability/us-dal...

> DALYs represent the total number of years lost to illness, disability, or premature death within a given population.

> DALYs are calculated by adding the number of years of life lost to the number of years lived with disability (YLDs) for a certain disease or disorder.

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There's a very interesting post Slate Star Codex about internal perception of wellbeing vs external behavior. TL;DR: there is a paper about people who claim to have experienced enlightenment, but often there's no changes in their behavior (that people around them, e.g. their friends and relatives, would notice). Scott warns against dismissing these experiences as "fake", arguing that we similarly don't dismiss claims of depression in people who are still "functional" and living their lives as usual.

https://slatestarcodex.com/2019/10/21/the-pnse-paper/

Plenty of depressed people act normally until they shock everyone in their social circle by suddenly committing suicide.

What's the mechanism? My point is that depression is such a wide category that even if it exists it's useless.

You could say that "being human" is a disease, it always leads to death. I'm not saying "being human" doesn't exist.

The pathophysiology of depression is not fully understood. It is possible that what we understand as depression today could become several distinct diseases in the future.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181668/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984887/

In any case, the impact of depression is known and it can't be ignored. Doctors must at least try to help depressed patients. There are models which guide pharmacological and behavorial treatments employed in current practice. They are proven to be superior to placebo.

That's my point. You haven't even come up with a basic taxonomy of depression and you're already applying your theory. In physics this would be blasphemous.

> Doctors must at least try to help depressed patients.

All the help I've received has been useless or actively harmful. No one even told me to exercise or diet, in fact, some suggested I take it easy, stop blaming myself.

That was all wrong. I was to blame. Every morning, by blaming myself, I made better choices w.r.t health. Now I am no longer to blame, I have no depression.

I used to be arthritic and asthmatic, now I am biking for hours straight, doing pull-ups every day.

> You haven't even come up with a basic taxonomy of depression and you're already applying your theory.

We have no choice but to apply these theories. The alternative would be to do nothing until they are perfected. That would be negligence.

Antidepressants do not have a 100% success rate. Nothing in medicine has. That doesn't mean they shouldn't be used.

> In physics this would be blasphemous.

Not really. Plenty of theories ended up being revised when humanity's understanding of the world improved. They still had real world applications: even though they were imperfect, they were good enough for a wide variety of uses.

We don't fully understand depression. We don't even fully understand how some medications work. However, we have studies showing that by taking these medications patients improve and mortality decreases. That's enough to justify their use.

> Not really. Plenty of theories ended up being revised when humanity's understanding of the world improved. They still had real world applications: even though they were imperfect, they were good enough for a wide variety of uses.

Those imperfect theories are applied today, and still work in lots of contexts. They are complete, but subsets. We can make predictions, given certain initial conditions, with accuracy as close to 100% as you require, the only issue is measurement. Comparing psychology to physics in this manner is pretty embarrassing, and shows a lack of understanding of physics.

Applying imperfect physical theories causes bombs to explode where they shouldn't, nuclear plants to react when they shouldn't. We don't build fusion reactors today because we still need to determine the safety of isolating the plasma.

> We have no choice but to apply these theories. The alternative would be to do nothing until they are perfected. That would be negligence. Antidepressants do not have a 100% success rate. Nothing in medicine has. That doesn't mean they shouldn't be used.

I didn't say they needed to have a 100% success rate. You just need to find the mechanism. I'd be happy with a 0.1% success rate if our determination of the mechanism implies that there is no cure once it reaches that stage.

Let's do a study--I think drinking alcohol has cured my depression. It doesn't have a 100% success rate, but it would be negligent to tell people that they shouldn't get plastered if they're depressed.

edit: Don't drink alcohol to cure your depression. I suspect the mechanism is related to the gut flora. Alcohol kills the gut flora.

> Applying imperfect physical theories causes bombs to explode where they shouldn't, nuclear plants to react when they shouldn't. We don't build fusion reactors today because we still need to determine the safety of isolating the plasma.

Failures in nuclear reactors can have disastrous outcomes for a huge number of people. Is this comparable to the use of prescription drugs under medical supervision? A failure in these cases means the patient may experience adverse effects for no benefit, a risk inherent in any treatment.

> You just need to find the mechanism.

People are working on it. Meanwhile, we have make the best of what we know right now.

> Let's do a study--I think drinking alcohol has cured my depression. It doesn't have a 100% success rate, but it would be negligent to tell people that they shouldn't get plastered if they're depressed.

Alcohol and depression aren't a good mix.

https://pubmed.ncbi.nlm.nih.gov/21382111/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799954/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712746/

> Alcohol and depression aren't a good mix.

Again my point, obviously I don't believe this to be true, but since it does have a positive success rate (there's no study which quantifies this, strangely enough, your studies are purely epidemiological, you'd have to take someone without ASD and then prescribe them ethanol at about 20% to actually study this) it would be negligent, as per your theory/ethics, to not prescribe this, and in fact it was prescribed in the past during prohibition [1]. Now, looking back this is obviously false.

> People are working on it. Meanwhile, we have make the best of what we know right now.

Great! The best of what we know right now is simply diet & exercise, no pill can prevent the onset of depression.

I think you'll find the taxonomy of depression to be a subset of existing disease categories. The brain, gut, and nervous system are connected in a chaotic manner.

PS. I don't drink at all, zero alcohol. I agree that it's probably very much related to all existing depression categories, correlated positively.

[1] https://www.smithsonianmag.com/history/during-prohibition-yo...

I can find a better source if you want, I'd have to do some digging.

Finally, hopefully you have already read this:

https://www.sciencedirect.com/science/article/abs/pii/S01650...

Anyways, thanks for the discussion, I don't expect to convince you. Maybe you'll think twice, however.

> The best of what we know right now is simply diet & exercise, no pill can prevent the onset of depression.

Absolutely. Healthy life style decreases the risk of depression and can help depressed patients. It's standard advice.

Prevention and treatment are different though. A patient who is already severely depressed and anhedonic and struggling to leave the bed is unlikely to suddenly start dieting an exercising. It makes sense to try and improve the symptoms prior to trying this.

> Prevention and treatment are different though.

There are different, but they are not mutually exclusive.

> A patient who is already severely depressed and anhedonic and struggling to leave the bed is unlikely to suddenly start dieting an exercising.

I had the same symptoms, I found that exercising and dieting was the only thing that gave me pleasure (other than alcohol or cannabis). During the thick of it I would do pull-ups by walking to the bar, knocking some out (if I had a RA flare-up then I would do planks), and then collapsing after my heart-rate went back down. The issue was that people kept telling me to keep eating carbohydrate, which was causing lots of inflammation (I had tons of visceral fat). I also found that direct sun exposure improved my symptoms a ton (I was talking a D3 supplement prior).

Maybe if we told people "We have no idea how to cure this--the only proven method is diet & exercise, and this often lead to an early death if you don't start now" it would work? Once I realized that myself, it was a huge kick in the ass. I was figuratively paralyzed because no one seemed to give me this most basic advice, and the only way to get to a psychologist where I live is to self-harm.

I know a cancer survivor who was told that, and she did it, at 65, and she was obese by a large margin with severe trauma from the chemo.

I'd agree in so far as it makes pulling scams (or innocently giving useless advice) far too easy:

"I had depression, and I tried X, and it worked. You've got depression, so you should try X." Extremely unlikely to be helpful, and often can be harmful.

Yes, it's like cancer, we don't know the cure but everyone rushes to tell you that you just need to take a pill and you'll feel better. Which pill?

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